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Query: UMLS:C0024523 (malabsorption)
 7,319 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

On the basis of two cases diagnosed by ourselves, and a review of literature the problematic Whipple's disease is demonstrated. The treatment of this rare disease is very successful but it is too seldom included in the differential diagnosis of arthralgia and malabsorption. Therefore fatal false diagnosis results very often.
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PMID:[The splendor and misery of Whipple's disease]. 245 69

A 45-year-old man developed migratory arthritis and fever, at first believed to be caused by rheumatoid arthritis. Whipple's disease was eventually diagnosed after a malabsorption syndrome had occurred and biopsies been taken from the distal duodenum and jejunum. The patient was cured after several months on tetracycline. In a second case, a 73-year-old woman, malabsorption of six months' duration resulting from Whipple's disease had brought about such deterioration that after hospitalisation she died despite a correct diagnosis and an appropriate treatment.
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PMID:[2 cases of Whipple's disease with different outcomes]. 245 9

A patient aged 45 suffering from Whipple's disease is described. The disease has been diagnosed on the basis of morphologic examination of a biopsy specimen of the small intestine mesenteric lymph node. The patient had suffered from the disease for 14 years; during the last 6 months he developed symptoms of the malabsorption syndrome with diarrhea and steatorrhea. The lymph nodes contained numerous macrophages with PAS-positive glycoprotein granules in the cytoplasm, small cavities filled with lipids; electron microscopy has revealed bacillus-like bodies in the macrophages and outside the cells. After the disease has been diagnosed, the patient has been administered a course of tetracycline therapy, that resulted in an improvement of his status.
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PMID:[The morphology of mesenteric lymph nodes in Whipple's disease]. 246 43

The neurologic manifestations of gastrointestinal disease are generally thought to be uncommon, although an increasing number of previously unidentified associations are being established. These neurologic disorders may result from nutritional or non-nutritional causes. In the absence of clear malnutrition, it is likely that many of these disorders are underdiagnosed. As an example, Wernicke's encephalopathy is found at autopsy in as many as 2 per cent of brains, a very high percentage, given the rare recognition during life. The likely underdiagnosis of nutritional neurologic disorders is unfortunate because many are treatable and, more importantly, are preventable if malabsorption is suspected and appropriate supplementation initiated. For the neurologist, familiarity with the occasional association between neurologic abnormalities and specific gastrointestinal disorders is important, as is familiarity with the neurologic characteristics of disorders, such as Whipple's disease, that may present as isolated neurologic syndromes without gastrointestinal symptoms or signs. Renewed interest in selective deficiency states has resulted in identification of causative factors in several neurologic syndromes of previously presumed degenerative etiology. Recognition of the potential neurologic consequences of prolonged deficiency states also is important for the internist, because many of the syndromes are poorly reversible once symptomatic. The benefits of prevention invariably exceed those of treatment.
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PMID:Neurologic manifestations of gastrointestinal disease. 254 60

Whipple's disease is a curious disorder with the involvement of many organ systems, primarily gut, synovium and the central nervous system, characterized by the presence of numerous proliferating bacteria in tissue macrophages and other cell types. While clinically this disease entity has previously been defined by the classical triad of diarrhoea, malabsorption and weight loss, some patients do not show these features. In this report, a clinically unusual case of Whipple's disease is described presenting with high persistent fever, severe arthralgias and headaches, but without malabsorption, diarrhoea or weight loss. Nevertheless, the histological and electron microscopical pictures demonstrated the typical findings of intracellular micro-organisms along with the presence of bacteria in Schwann nerve cells, which has only once been described previously. Immunological findings before treatment demonstrated a decrease of T cells with the helper/inducer phenotype, and a concomitant rise in cells with the suppressor/cytotoxic phenotype, an elevation of "activated" Ia positive T cells and a significant reduction of T cell mitogenic responsiveness. Of special interest, after a successful treatment these immunological abnormalities shifted to normal with the exception of a still elevated number of Ia+ T cells. The discussion of this unusual case of Whipple's disease includes - besides possible cellular immunological abnormalities - genetic factors, especially since this patient was HLA-B-27-positive as was his son who is suffering from ankylosing spondylitis.
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PMID:[Immunologic and electron microscopic findings in an unusual case of Whipple's disease]. 258 Jan 16

At endoscopy, a 30-year-old man with acquired immune deficiency syndrome (AIDS), Kaposi's sarcoma, diarrhea, and unexplained malabsorption showed erythematous macular duodenal lesions consistent with Whipple's disease by histology and electron microscopy. Symptoms did not respond to tetracycline. Subsequent cultures revealed systemic Mycobacterium avium (M. avium) infection. Tissue from this patient, from patients with Whipple's disease and from a macaque with M. avium were compared. All contained PAS-positive macrophages but M. avium could be distinguished by positive acid-fast stains and a difference in pattern of indirect immunofluorescence staining with bacterial typing antisera. PAS-positive macrophages in the intestinal lamina propria are no longer pathognomonic of Whipple's disease. Ultrastructural and histological similarities between Whipple's disease and M. avium infection suggest that both are manifestations of immune deficits limiting macrophage destruction of particular bacteria after phagocytosis. M. avium must be considered in the differential diagnosis of diarrhea in patients with AIDS and other immunosuppressed conditions.
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PMID:Intestinal infection with Mycobacterium avium in acquired immune deficiency syndrome (AIDS). Histological and clinical comparison with Whipple's disease. 258 Jun 79

We retrospectively analyzed the small bowel radiographies, performed by enteroclysis in 73 patients presenting a malabsorption disease. The etiology are: celiac disease (44 cases), abetalipoprotidemia (2 cases), Whipple's disease (7 cases), mastocytosis (1 case), amyloidosis (1 case), ischemia enteritis (4 cases), radiation injury (4 cases), lymphangiectasia (4 cases), Crohn's disease (4 cases) and NH lymphoma (2 cases). With enteroclysis, the radiological diagnosis of malabsorption disease is improved and it is able to differentiate malabsorption diseases based on radiological features: increased or decreased number of folds (celiac disease, mastocytosis, abetalipoprotidemia), nodularity of folds (Whipple's disease) and wall thickness (amyloidosis, lymphangiectasia, ischemic enteritis and radiation injury). It is no possible to differentiate NH lymphoma from Crohn's disease.
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PMID:[Enteroclysis in malabsorption syndrome in adults. Apropos of 73 cases]. 273 73

A male born to first cousins presented at 12 months with hypocalcemic convulsions, rickets, epistaxis due to vitamin K deficiency, and extremely low serum levels of beta-carotene and vitamin A. Liver function was altered moderately (glutamic-oxaloacetic transaminase, 55 U/L; glutamic-pyruvic transaminase, 37 U/L; lactate dehydrogenase, 255 U/L; alkaline phosphatase, 437 U/L). To correct the deficiencies, 8,000 IU vitamin D/day, 10,000 IU vitamin A/day, and intramuscular administration of vitamin K1 were required. At 9 years, he presented signs of neuromuscular affection, and the serum vitamin E level (measured for the first time) was extremely low. Classic lipid malabsorption syndromes (abetalipoproteinemia, chronic cholestasis, mucoviscidosis, coeliac disease, Whipple's disease) were excluded by appropriate examinations. Composition of duodenal bile acids was characterized by undetectable levels of cholic acid metabolites, and only chenodeoxycholic acid metabolites were present. Serum total bile acid concentration was normal, with an atypical low cholic acid/chenodeoxycholic acid ratio and abnormal presence of 3 beta-OH-delta 5-cholenic acid and 6-OH-bile acids. Urinary bile acid composition was also characterized by elevated 6-OH-bile acids. Known enzymopathies of the bile acid synthetic pathway were excluded (cerebrotendinous xanthomatosis, cerebro-hepato-renal syndrome of Zellweger, coprostanic acidemia). Bile acid pool sizes were determined by using stable isotopes: cholic acid pool size [2.90 (N, 32 +/- 16) microM/kg] and chenodeoxycholic acid pool size [10.8 (N, 32.6 +/- 9.9) microM/kg] were extremely low; fractional turnover rates of both bile acids were in a normal range.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Malabsorption of liposoluble vitamins in a child with bile acid deficiency. 379 31

Biopsies of the proximal small bowel were obtained in four children with impairment of cell-mediated immunity, chronic diarrhia, and malabsorption; one child had an isolated T cell defect and three had significant B and T cell defects. All of them had malabsorption and, in addition to alterations of the small bowel epithelium, large vacuolated macrophages were seen in the lamina propria in all biopsies. Electron microscopy demonstrated lipid and patches of small pleomorphic inclusions within the macrophages. Since large vacuolated macrophages have also been described in Whipple's disease and chronic granulomatous disease, we suggest the possibility of a common thread of defective host defense and gastrointestinal malfunction in these three conditions.
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PMID:Small intestinal disease in T cell deficiency. 454 37

We describe an unusual case of Whipple's disease, in a patient previously treated for tuberculosis, in which involvement of the small intestine was restricted to the submucosa. This is of diagnostic importance since the presence of Whipple's disease cannot be established by jejunal biopsy in such cases unless the submucosa is adequately sampled. It is possible that this unusual distribution of intestinal infection is related to the effects of e antibiotic therapy. Retrospective study of the patient's serum cholesterol, carotene, and albumin suggests that malabsorption may occur in Whipple's disease despite the absence of infection in the mucosa.
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PMID:A submucosal variant of Whipple's disease. 617 78


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